Models of Multidisciplinary Working in Children's Trusts was a project being undertaken by the ACE Centresworking in partnership with pathfinder children's trusts. The project aimed to develop new and improved protocols for the provision and support of assistive technology and augmentative and alternative communication.
Historically the support and provision for children & young people who use AT and AAC has been patchy with some areas of the coountry providing high standard and effective services while other localities have minimal or non-existant services.
The project enabled the ACE Centres to work in four Children's Trust Pathfinders around the country to help them establish and develop their own local service for young people with AT and AAC needs. Each Children’s Trust has its own particular circumstances and priorities so consequently four different models have been established which can be used as exemplars on which other Children’s Trusts might base similar services in the future.
The Four Project Partner Trusts were Bolton, Brighton & Hove, Croydon and North & North East Lincolnshire. Each Trust started the project at different stages in their development of AAC & AT services. One Trust had a long established service which had to change following the end of the Communication Aids Project (CAP) while the other Trusts started with only fledgling or non existent services.
During the project each Trust has developed a model that suits their particular circumstances. With support and training from the ACE Centres each Trust has identified a service delivery model which includes staffing and funding structures, a written AAC policy, referral and assessment protocols and reporting procedures. They have established multi-disciplinary assessment teams for service delivery and have either identified funding streams or have considered how resources will be funded.
The four Trusts working with the project have very different backgrounds with different levels of involvement with AAC services prior to, during and post- CAP. They have different funding systems and structures including levels of devolved funding to schools and consequent levels of centrally retained funds. In addition they have different levels of commitment to supporting this group of children, young people and their families.
Where services exist or are developing the Trusts are benefiting from the high levels of interagency working required to ensure children and young people who need AT or AAC are assessed and supported adequately. All four Trusts either have or are developing multi-agency models of working, bringing together a range of professionals, including Speech & Language Therapists, Occupational Therapists, Physiotherapists, Teachers, engineers and technicians. This model is enabling the different professionals to develop and share new skills and experiences and ensures children & young people receive a wide ranging and thorough assessment combined with the high levels of support and training required to ensure they derive the maximum benefit from devices and systems provided. This model also ensures parents, carers and families can meet the range of professionals together to discuss needs and solutions.
All of the Trusts taking part in the project are reliant on the high level of commitment from one or more individuals. This confirms The ACE Centres’ experience that where AAC services exist it is often due to a ‘champion’ who has pushed, cajoled and persuaded fund holders and commissioning managers to invest in this area and that this will reap benefits. The experience in two of the four Trusts involved with the project also reinforce our experience that changes in key staff and loss of champions can have a substantial impact on a Trust’s desire and/or ability to support AAC services. There is very little, if any, consideration of succession planning within AAC services nationally even though the experiences in Bolton and Brighton & Hove clearly demonstrates the huge detrimental effect of key staff leaving a service.
The four Trusts illustrate that a long term commitment to ring fenced funding of both services and equipment is required. Where this type of funding is not available services have a hand to mouth, uncertain future which prevents the development and implementation of policies and procedures. Experience demonstrates that funding direct from either the Local Authority or Health service is less secure than pooled funding from both the LA and Health.
Important Factors for Successful AT & AAC Service Provision
- The involvement of senior managers and fundholders at a steering group or committee level.
- An AAC policy document or statement which includes a defined management structure, details of funding mechanisms, criteria for accessing the service and establishes procedures and practices. This policy should be widely available to parents, carers and professionals.
- An experienced and well trained multi-agency team of professionals who have the opportunity to develop their knowledge and skills through a programme of continuing professional development.
- An identified coordinator who will receive referrals and coordinate assessments and support.
- Assessment team members have time allocated to planning, preparing and providing the service rather than as an addition to their role without appropriate time allocated.
- Funding for staffing and resources is in place. Our experience suggests that ring-fenced funding is the only way to ensure children, young people and families have access to the services and resources they require. In many Trusts with established AT & AAC services some form of joint funding arrangement is in place. Joint or pooled funding for equipment recognises the wider importance of communication beyond the educational setting. Communication is an essential element of all social interaction and as such is required all day, every day.
- Consideration of succession issues is essential. When a key member of clinical staff or a manager leave, the service can take a considerable time to identify and train new staff. This was exemplified in two of the four Trusts which participated in the project. With succession planning this hiatus can be minimised and the Trust can benefit from the additional expertise which is available.
- The one Trust which has established a pooled budget is the only Trust which does not have to argue for equipment funding on a case-by-case basis and offers a far more efficient service as a consequence.
Many of the findings and recommendations from this project mirror those of other recent projects and reports on AAC. The Bercow Report (2008) and the SCOPE No Voice, No Choice: Professional experiences of the provision and support of Alternative and Augmentative Communication (AAC) report (2008) have made similar recommendations including the importance of multi-disciplinary working, the need for a communication champion (at national and local levels), the need for training and CPD for AAC professionals and the need for an AAC policy at both Trust and school level. The government’s response to the Bercow Report, ‘Better Communication’ (2008) has continued these themes with funding for Pathfinders and Pilots to explore multi-disciplinary working, commissioning and funding routes, workforce development and the appointment of a communication champion.